Terry Kemple is a retired GP, Bristol; has various roles promoting greater sustainability in general practice, including as Director for the Royal College of General Practitioners (RCGP) Green Impact for Health Toolkit; and is past President of the RCGP.
Trust is not visible, but you miss it when you lose it. Trust develops from many inputs that include memories, beliefs, and emotions that help us predict how someone may act. Stephen Covey says ‘Trust is the glue of life. It’s the most essential ingredient in effective communication. It’s the foundational principle that holds all relationships.’ 1 When trust is lost our belief in the words, facts and promises given and the actions taken is lost. Trust is an under-managed asset in health care.
“Trust is the glue of life. It’s the most essential ingredient in effective communication. It’s the foundational principle that holds all relationships.”
Its meaning and power are rarely described. The General Medical Council says: ‘Patients must be able to trust medical professionals with their lives and health. To justify that trust you must make the care of patients your first concern, and meet the standards expected of you in all four domains [of good medical practice].’ 2 The fourth domain, ‘trust and professionalism’, adds, ‘Patients must be able to trust medical professionals with their lives and health, and medical professionals must be able to trust each other.’ 3
The Royal College of General Practitioners GP curriculum expects ‘Through confidential trusted partnerships with their patients (characterised by empathy and mutual trust, without bias or judgement), GPs provide evidence-informed personalised care in the community in an accessible way.’ 4
The 2025 GP Patient Survey reports that patients have high trust (93%) in the healthcare provider they last saw in general practice.5 Other feedback is less reassuring. The 2025 National Centre for Social Research’s British Social Attitudes survey asked members of the public about their views on, and feelings towards, the NHS and health and care issues generally; 21% were satisfied with the NHS overall, while 59% were dissatisfied. Overall, 61% were dissatisfied about how long it takes to secure a GP appointment.6
Any increasing dissatisfaction is worrying. Barbara Starfield’s research showed that improved population health outcomes are associated with larger, stronger, and more integrated primary care systems.7 Her four pillars for primary care are that it should provide: first contact access, continuity, comprehensiveness, and care coordination. These are being weakened in general practice.8 Is this putting continuing trust in GPs at risk?
Trust means believing that a person or organisation is honest, capable, and dependable, and that they won’t purposely cause harm. It also means being willing to rely on them, expecting that they will do what’s best for you and keep their promises. It develops over time through consistent, reliable actions, and is an essential part of healthy relationships and working well together.
“What is to be done in general practice? Trust needs to be reasserted.”
What is to be done in general practice? Trust needs to be reasserted. Trust in health care is not all or nothing. For example, we may trust our GP’s advice but not trust getting a timely appointment. The most robust predictors of trust in health care seem to be good communication, shared decision making and patient involvement, clinical competence and ethical behaviour, continuity of care and sufficient encounter time, positive healthcare experiences, and system transparency.9 Poor communication, rushed interactions, perceived conflicts of interest, negative prior experiences with health care and discrimination, and unmet expectations harm trust. As patients experience different episodes of care from different individuals provided by different organisations at different locations there are fewer opportunities to build trusting relationships.
Jimmy Wales, a Wikipedia founder, has seven rules to follow to build trust:10
- Trust happens between people, not institutions. Trust is built one person at a time and can be lost easily.
- People want to connect and work together. Most people enjoy working with others.
- People need a clear, positive reason to work together. When everyone understands the purpose, teamwork and trust comes much more naturally.
- If you want trust, give trust first. Trust tends to come back when you’re willing to offer it upfront.
- Respect has to be taught — and modelled. It’s not enough to talk about civility. You have to show it in how you act every day.
- Know your mission and stick to it. Stay focused on what you’re here to do, and don’t get dragged into other people’s battles.
- Openness builds trust. When people can see what’s going on and why decisions are made, trust grows.
All of the above can be addressed in general practices. GPs can start by reversing the loss in personal continuity of patient care by bringing back more family doctor style personal care.11 Practices with many part-time GPs, often using personal lists, report levels of GP continuity between 55% and 65%,12 with highest levels over 80%.13
Rebuilding stronger, trusting relations between patients and their GPs could improve the experience and the outcomes of care both for patients and their GPs.
References
1. Covey SR, Covey S. The 7 habits of highly effective people. London: Simon and Schuster UK, 2020.
2. General Medical Council (GMC). The duties of medical professionals registered with the GMC. https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice/the-duties-of-medical-professionals-registered-with-the-gmc (accessed 19 Feb 2026).
3. GMC. Domain 4: trust and professionalism. https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice/domain-4-trust-and-professionalism (accessed 19 Feb 2026).
4. Royal College of General Practitioners. The RCGP curriculum: being a general practitioner. 2025. https://www.rcgp.org.uk/getmedia/8437edbc-1960-4eac-89d9-f657e2f28753/being-general-practitioner-2025.pdf (accessed 19 Feb 2026).
5. NHS. GP Patient Survey 2025 survey: headline findings. 2025. https://gp-patient.co.uk/FileDownload/Download?fileRedirect=2025%2Fsurvey-results%2Fnational-results%2Fnational-infographic%2FGPPS_2025_National_infographic_PUBLIC.pptx (accessed 19 Feb 2026).
6. Curtice J, Sivathasan C, Morton G. BSA 42. Repairing Britain: attitudes towards the economy, taxation and public services. 2025. https://natcen.ac.uk/sites/default/files/2025-06/bsa-42-%7C-repairing-britain-1676.pdf (accessed 19 Feb 2026).
7. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005; 83(3): 457–502.
8. Sinnott C, Ansari A, Price E, et al. Experiences of access to general practice in England: qualitative study and implications for the NHS 10 year plan. BMJ 2026; 392: e087367.
9. Lerch SP, Hänggi R, Bussmann Y, Lörwald A. A model of contributors to a trusting patient-physician relationship: a critical review using a systematic search strategy. BMC Prim Care 2024; 25(1): 194.
10. Wales J. The seven rules of trust: why it is today’s most essential superpower. London: Bloomsbury, 2025.
11. Kemple T. Bringing back or taking forward the ‘family doctor’? BJGP Life 2023; 7 Jul: https://bjgplife.com/bringing-back-or-taking-forward-the-family-doctor (accessed 19 Feb 2026).
12. Sidaway-Lee K, Pereira Gray D, Evans P. A method for measuring continuity of care in day-to-day general practice: a quantitative analysis of appointment data. Br J Gen Pract 2019; DOI: https://doi.org/10.3399/bjgp19X701813.
13. Sayers LD, Richardson S, Colvin D, et al. Realistic not romantic — real-world continuity in action. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X735909.
I feel the best way to emphasise the problems with trust in the GP Service is to list the problems.
1. Making an appointment requres computer/phone literacy
2. The method of making appointments is not transparent.
3. Waiting rooms are overcrowded and look unhygenic.
4. The reception staff are answering the phone before talking to patients queuing.
5. Reception staff are sullen and unhelpful.
6. Doctors always ask “what can I do for you” and do not seem to know anything about your medical history.
7. It is apparent they cannot see on their screen what you wrote when making the appointment on line.
8. Most GPs are reluctant to touch the patients.
9. GPs frequently shy away from even looking at the patient’s relevant body part.
10. Skin conditions are invariably ignored unless appearing cancerous.
11. If you are made to wait beyond your appontment time, you will receive a shorter consultation.
13. Referals for skin and rheumatoid conditions usually are discouraged because of excessive waiting lists.
14. Most GPs show no real interest in the well being of the patient.
15. Older patients are often told outright that their symptoms are just a part of old age even when this is clearly not the case.
16. The restrictions on who qualifies for covid and flu vaccinations keep changing and are too rigidly adhered to.
17. GP Consultations are recorded to automatcally generate “notes”.
18. GPs appear very unhappy in their roles and rarely interact with the patient in a friendly manner.
19. Patients are left feeling that they are a burden on the NHS.
20. Practice managers never engage with patients
21. Phone calls are often used to convey test results to patients rather than providing copies of the actual results.
22. Adverse/dangerous drug interactions are not checked before prescribing a new medication for patients.
23. Gps frequently ask “what do you want me to do? but then refuse to do it.
24. GPs do not understand many conditions and are reluctant to improve their knowledge, ie “life long learning”.
I may think of more